118 results on '"Daas A"'
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2. Descemet Membrane Endothelial Keratoplasty after failed penetrating keratoplasty– case series and review of the literature
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Agata Anna Wykrota, Loïc Hamon, Loay Daas, and Berthold Seitz
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Cornea ,Descemet Membrane Endothelial Keratoplasty ,Graft failure ,Graft undersizing ,Sequential keratoplasty ,Ophthalmology ,RE1-994 - Abstract
Abstract Background This study aims to evaluate visual outcome, central corneal thickness, and re-bubbling rate in a cohort with undersized sequential Descemet Membrane Endothelial Keratoplasty (DMEK) due to endothelial graft decompensation following primary penetrating keratoplasty (PK). Methods All patients who received a sequential DMEK (n = 16) or triple DMEK (n = 2) after failed primary PK between November 2020 and June 2022 were retrospectively evaluated. Analyzed parameters were corrected distance visual acuity (CDVA), central corneal thickness (CCT), re-bubbling rate and graft survival. Results 18 eyes of 18 patients were included. All patients underwent a DMEK with undersized graft after failed PK(s). Mean time between the last PK and DMEK was 102 ± 82 weeks. Mean follow-up time was 8.9 ± 4.6 months. CDVA increased significantly from 1.12 ± 0.60 logMAR preoperatively to 0.64 ± 0.49 logMAR 6 weeks postoperatively (p = 0.013). Mean CCT decreased significantly from 807 ± 224 μm before to 573 ± 151 μm 6 weeks after DMEK (p = 0.003). Re-bubbling was necessary in eight eyes (44.4%) after a median time of 7 days. The 12-month Kaplan Meier survival was 66.7%. Conclusion In case of endothelial graft decompensation without stromal scars after primary PK, a DMEK can be performed for selected patients who had satisfying CDVA before the endothelial decompensation. Prior to DMEK indication, an AS-OCT should routinely be performed to circularly search for posterior steps at the PK graft margin, as well as shortly after DMEK to exclude a detachment of the endothelial graft. All patients should be informed about a higher re-bubbling rate in comparison to primary DMEK.
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- 2024
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3. Review for special issue: Corneal lamellar surgery: Present outcomes and future perspectives
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Loïc Hamon, Isabel Weinstein, Adrien Quintin, Tarek Safi, Max Bofferding, Loay Daas, and Berthold Seitz
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cold storage ,cornea ,donor tomography ,eye bank ,organ culture ,prestripped tissues ,quality management ,Ophthalmology ,RE1-994 - Abstract
Since the establishment of the first eye bank in the 1940s, their role has evolved to face new challenges. With the recent development of lamellar keratoplasties, eye banks play an even bigger role in the selection and preparation of donor tissues. The increasing number of keratoplasty techniques and the high demand for “ready-to-use” tissues are challenging eye banks to improve and develop new preparation techniques. Besides necessary examinations, new approaches of tissue analysis in eye banks allow a better/optimized selection of corneal tissues. These new challenges in tissue preservation, preparation, and selection are propelling eye banks into a new era of modern eye banking.
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- 2024
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4. Evaluation of dynamic corneal response parameters and the biomechanical E-staging after Intacs® SK implantation in keratoconus
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Elias Flockerzi, Tim Berger, Berthold Seitz, Loic Hamon, and Loay Daas
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biomechanical e-staging ,biomechanics ,cbi ,cbif ,corvis ,intracorneal ring segments ,keratoconus ,Ophthalmology ,RE1-994 - Abstract
Purpose: This retrospective longitudinal study evaluated the biomechanical E-staging in KC corneas before and after intracorneal ring segment (ICRS) implantation (Intacs® SK, Addition Technology, Illinois, United States). Methods: Biomechanical E-staging for ectatic corneal diseases was applied retrospectively on 49 KC corneas of 41 patients who underwent ICRS implantation. The main outcome parameters included the Corvis Biomechanical Factor (CBiF, the linearized Corvis Biomechanical Index and the biomechanical parameters included), the resulting biomechanical E-staging, the stress-strain index, thinnest corneal thickness (TCT), maximal anterior keratometry (Kmax), and the anterior radius of curvature (ARC). They were evaluated at 1.9 ± 1.1 months preoperatively and postoperatively after 2.8 ± 0.7, 5.8 ± 1.0, and 10.6 ± 2.3 months. Results: The CBiF decreased (4.9 ± 0.5 | 4.7 ± 0.5, P = 0.0013), and the E-staging increased significantly (2.8 ± 0.8 | 3.1 ± 0.9, P = 0.0012, paired t-test) from preoperatively to the first postoperative follow-up. The difference remained significant after 6 months; however, there was no more difference after 11 months. TCT was stable, whereas Kmax and ARC significantly decreased after ICRS implantation (TCT: 464 ± 49, 470 ± 51, 467 ± 38, 461 ± 48; Kmax: 56.3 ± 4.5, 54.7 ± 4.5, 54.2 ± 4.8, 54.1 ± 4.3; ARC: 51.5 ± 3.4, 48.3 ± 3.8, 48.6 ± 3.0, 48.6 ± 3.2 preoperatively and 3, 6, and 11 months postoperatively, respectively). Besides Kmax and ARC, Ambrósio’s relational thickness to the horizontal profile (ARTh) was the only parameter that was significantly lower than preoperatively at any follow-up (P ≤ 0.0024, Wilcoxon matched-pairs test). Conclusion: Intacs® SK implantation results in an increasing biomechanical E-staging in the first postoperative months with stabilization near preoperative values after 1 year. Significantly lower ARTh values at any follow-up document the ICRS effect and contribute to a slightly higher postoperative biomechanical E-staging value.
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- 2024
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5. P42-A105 Sterile donor tomography for improvement of refractive results after keratoplasty
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Loïc Hamon, Achim Langenbucher, Berthold Seitz, Adrien Quintin, Stephanie Mäurer, Loay Daas, and Max Bofferding
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Ophthalmology ,RE1-994 - Published
- 2023
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6. P06-A143 An artificial-intelligence-based decision support tool for the detection of Cornea guttata on the donor corneas in the eye bank
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Berthold Seitz, Loay Daas, Tarek Safi, Matthias Nadig, and Jan Alexandersson
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Ophthalmology ,RE1-994 - Published
- 2023
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7. P23-A137 Cross-border cooperation for corneal donation between lions eye bank Saar-Lor-Lux, Trier/Westpfalz in Homburg/Saar and Luxembourg
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Loïc Hamon, Berthold Seitz, Adrien Quintin, Isabel Weinstein, Loay Daas, and Max Bofferding
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Ophthalmology ,RE1-994 - Published
- 2023
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8. Outcomes of Severe Fungal Keratitis Using in vivo Confocal Microscopy and Early Therapeutic Penetrating Keratoplasty
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Sourlis C, Seitz B, Roth M, Hamon L, and Daas L
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fungal keratitis ,in vivo confocal microscopy ,penetrating keratoplasty ,Ophthalmology ,RE1-994 - Abstract
Chrysovalantis Sourlis,1 Berthold Seitz,1 Mathias Roth,2 Loïc Hamon,1 Loay Daas1 1Department of Ophthalmology, Saarland University Medical Center, UKS, Homburg/Saar, Germany; 2Department of Ophthalmology, Heinrich-Heine University Düsseldorf, Düsseldorf, GermanyCorrespondence: Loïc Hamon, Department of Ophthalmology, Saarland University Medical Center, UKS, Homburg/Saar, Germany, Tel +49-6841-1622387, Fax +49-6841-1622400, Email loic.hamon@uks.euPurpose: The purpose of this study was to assess the impact of early diagnosis using in vivo confocal microscopy and early therapeutic penetrating keratoplasty (TPK) on the outcomes of severe cases of fungal keratitis.Methods: This retrospective single-center study included 38 patients (40 eyes) with fungal keratitis who presented between December 2013 and February 2020. Preoperative, intraoperative, and postoperative parameters were recorded to assess the role of early correct diagnosis and early surgical therapy on visual acuity outcome and enucleation rate during follow-up.Results: The mean patient age was 51 years (71% females). The initial external diagnosis was correct in 20 cases (50%). The mean time from symptom onset until admission to our department was 46.8 ± 68.0 (median 28.5) days. The mean time to correct diagnosis after admission to our department was 1 day with in vivo confocal microscopy (IVCM). IVCM was performed in 38 cases, of which 36 (sensitivity: 94.7%) were positive for fungal infection. Twenty-seven out of 40 (67.5%) eyes received a TPK 4.2 ± 3.9 days after admission, with a mean graft size of 8.9 ± 1.9 mm. Three eyes (7.5%) were enucleated. The corrected distance visual acuity of the entire study population increased from 2.0 ± 1.2 LogMAR to 0.96 ± 1.17 LogMAR.Conclusion: In vivo confocal microscopy is a powerful tool for the early detection of fungal organisms in infectious keratitis. An early TPK with a large graft helps to eradicate the infection timely and results in a favorable visual acuity outcome and lower enucleation rate, especially when treating filamentous fungi.Keywords: fungal keratitis, in vivo confocal microscopy, penetrating keratoplasty
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- 2022
9. 16 Reliability and efficiency of corneal thickness measurements using sterile donor tomography in the eye bank
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Loïc Hamon, Achim Langenbucher, Berthold Seitz, Adrien Quintin, Stephanie Mäurer, Isabel Weinstein, and Loay Daas
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Ophthalmology ,RE1-994 - Published
- 2022
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10. Reactive uveitis, retinal vasculitis and scleritis as ocular end-stage of Acanthamoeba keratitis: a histological study
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Lei Shi, Tobias Hager, Fabian Norbert Fries, Loay Daas, Leonard Holbach, Carmen Hofmann-Rummelt, Elena Zemova, Berthold Seitz, and Nóra Szentmáry
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acanthamoeba keratitis ,enucleation ,uveitis ,retinal vasculitis ,scleritis ,Ophthalmology ,RE1-994 - Abstract
We analysed histologically two Acanthamoeba keratitis (AK) eyes with anterior and posterior segment inflammation and blindness. Two enucleated eyes of 2 patients (age 45 and 51y) with AK (PCR of epithelial abrasion positive) were analysed. Histological analysis was performed using hematoxylin-eosin, periodic acid-Schiff and Gömöri-methenamine silver staining. We could not observe Acanthamoeba trophozoites or cysts neither in the cornea nor in other ocular tissues. Meanwhile, we found uveitis, retinal vasculitis and scleritis in these eyes, due to the long-standing, recalcitrant AK. So in this stage of AK, systemic immune suppression may be necessary for a longer time period.
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- 2019
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11. Acanthamoeba keratitis – Clinical signs, differential diagnosis and treatment
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Nóra Szentmáry, Loay Daas, Lei Shi, Kornelia Lenke Laurik, Sabine Lepper, Georgia Milioti, and Berthold Seitz
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Ophthalmology ,RE1-994 - Abstract
Purpose: To summarize actual literature data on clinical signs, differential diagnosis, and treatment of acanthamoeba keratitis. Methods: Review of literature. Results: Clinical signs of acanthamoeba keratitis are in early stages grey-dirty epithelium, pseudodendritiformic epitheliopathy, perineuritis, multifocal stromal infiltrates, ring infiltrate and in later stages scleritis, iris atrophy, anterior synechiae, secondary glaucoma, mature cataract, and chorioretinitis. As conservative treatment, we use up to one year triple-topical therapy (polyhexamethylene-biguanide, propamidine-isethionate, neomycin). In therapy resistant cases, surgical treatment options such as corneal cryotherapy, amniotic membrane transplantation, riboflavin-UVA cross-linking, and penetrating keratoplasty are applied. Conclusion: With early diagnosis and conservative or surgical treatment, acanthamoeba keratitis heals in most cases. Keywords: Acanthamoeba, Keratitis, Cornea, Contact lens
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- 2019
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12. In Vitro Expression Analysis of Cytokines and ROS-Related Genes in Human Corneal Fibroblasts and Keratocytes of Healthy and Keratoconus Corneas
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Tim Berger, Nóra Szentmáry, Ning Chai, Elias Flockerzi, Loay Daas, Tanja Stachon, and Berthold Seitz
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Ophthalmology ,Immunology and Allergy - Published
- 2023
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13. Evaluation of Dynamic Corneal Response Parameters and the Biomechanical E-Staging After Accelerated Corneal Cross-Linking in Keratoconus
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Elias, Flockerzi, Kassandra, Xanthopoulou, Loay, Daas, Simon, Feld, Achim, Langenbucher, and Berthold, Seitz
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Photosensitizing Agents ,Ultraviolet Rays ,Riboflavin ,Visual Acuity ,Corneal Topography ,General Medicine ,Keratoconus ,Cornea ,Ophthalmology ,Photochemotherapy ,Humans ,Longitudinal Studies ,Collagen ,Retrospective Studies - Abstract
This study evaluated the biomechanical E-staging in progressive keratoconus (KC) corneas before and after epithelium-off accelerated corneal cross-linking (CXL, 9 mW/cm2, 10 min, 5.4 J/cm2).German university-based retrospective longitudinal cohort study.The biomechanical E-staging for ectatic corneal diseases was applied retrospectively on 49 progressive KC corneas of 41 patients who underwent CXL. Main outcome parameters included the Corvis Biomechanical Factor (CBiF, the linearized Corvis Biomechanical Index), the biomechanical E-staging (E1 to E4 result of dividing the CBiF value range into 5 groups), maximal anterior keratometry (Kmax), anterior radius of curvature (ARC), and thinnest corneal thickness (TCT). They were evaluated at 2.1±2.0 months preoperatively (n=49 corneas, 41 patients) and postoperatively after 5.4±1.4, 11.3±1.8, and 23.4±1.6 months.The CBiF decreased (5.1±0.5 | 5.0±0.5, P=0.0338) and the E-staging increased significantly (2.4±0.9 | 2.6±0.8, P=0.0035) from preoperatively to the first postoperative follow-up. The difference was not significant after 11 months and there were same values after 23 months. Kmax, ARC, and TCT slightly decreased (Kmax: 56.9±6.3, 54.3±5.1, 56.2±6.6, 54.0±5.2; ARC: 49.8±3.5, 48.9±3.2, 50.8±5.6, 49.0±3.7; TCT: 470±34, 454±36, 459±35, 466±39; preoperatively and 5, 11, and 23 months postoperatively). A postoperatively decreased TCT was associated with an increased E-stage, whereas an equal or increased TCT measurement after CXL was associated with equal or lower E-staging results.The biomechanical E-staging in KC corneas is influenced by TCT measurements and increases within the first postoperative months after CXL. On the long term, it indicates a postoperative KC stabilization, with comparable E-values to preoperatively at 11 and 23 months after CXL.
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- 2022
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14. Clinical Comparison of the Performance of Two Marketed Ophthalmic Viscoelastic Devices (OVDs): The Bacterially Derived Healon PRO OVD and Animal-Derived Healon OVD
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Loay Daas, Jose Manuel Larrosa, Alicia Gavin, Carlos Isanta, Achim Langenbucher, Beth E. Jackson, Linda Tsai, Priya Janakiraman, Rafael Guerrero, and Berthold Seitz
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Ophthalmology ,RE1-994 - Abstract
This clinical investigation compared the clinical performance of two marketed ophthalmic viscoelastic devices (OVDs): the bacterially derived Healon PRO OVD (test) and the animal-derived Healon OVD (control) under normal use conditions during cataract removal and lens implantation. This prospective, multicenter, randomized, parallel, participant/evaluator masked, postmarket investigation enrolled 139 subjects (170 eyes), 116 (143 eyes) of which were treated (73 test; 70 control group). Both test and control OVDs were used, at a minimum, to inflate the anterior chamber and protect the endothelium prior to cataract extraction according to the standard procedure. The surgeon completed a postsurgery OVD clinical performance questionnaire, and intraocular pressure (IOP) was measured before surgery and at the 1 day postoperative visit with Goldmann applanation tonometry. Any IOP measurement of 30 mmHg or higher was considered a “spike” and recorded as a study-specific, serious adverse event. The bacterially derived Healon PRO OVD was found to be statistically noninferior to the overall clinical performance of the animal-derived Healon OVD control; thus, the primary hypothesis was satisfied. There were no statistically significant differences between OVD groups for any of the additional endpoints relating to IOP changes or to safety, thus satisfying additional hypotheses. The Healon PRO OVD showed statistically significant improvements in surgeon ratings for ease of injectability, transparency/visibility, and ease of IOL placement. The safety profile was also similar between OVD groups with regards to serious and/or device-related adverse events, as well as medical and lens findings. The results of this clinical investigation support the safety and effectiveness of the bacterially derived, currently marketed Healon PRO OVD and indicate that the intraocular surgical performance was similar between the two OVDs.
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- 2020
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15. Hornhautulkus – Handlungspfad
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Loïc Hamon, Loay Daas, and Berthold Seitz
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Ophthalmology ,General Engineering - Published
- 2022
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16. Transplantatversagen nach PKP und DMEK: Was ist die beste Option?
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Berthold Seitz, Loay Daas, Agata Anna Wykrota, Elias Flockerzi, and Shady Suffo
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Ophthalmology - Abstract
ZusammenfassungDie Hornhauttransplantation ist das weltweit am häufigsten durchgeführte Verfahren zur Transplantation von menschlichem Gewebe. Aufgrund der großen Anzahl von Transplantationen hat sich das Versagen von Hornhauttransplantaten aus immunologischen und nicht immunologischen Gründen (z. B. Rezidiv der Grunderkrankung, hoher Augendruck, transplantierte Guttae, übertragene HSV- oder CMV-Infektion) zu einer der häufigsten Indikationen für Hornhauttransplantationen entwickelt. Die relativ neuen lamellären Transplantationstechniken haben bestimmte potenzielle Komplikationen mit sich gebracht, die zu einem Transplantatversagen führen und andere Ansätze als die perforierende Keratoplastik für eine erneute Transplantation erforderlich machen können. Andererseits bieten diese neuen lamellären Techniken auch neue Möglichkeiten zur Rettung fehlgeschlagener perforierender Transplantate, mit potenziellen Vorteilen gegenüber aufeinanderfolgenden perforierenden Keratoplastiken, wie z. B. geringere intraoperative Risiken, schnellere visuelle Rehabilitation und reduziertes Abstoßungsrisiko. Heute stellt bei gutem Heilungsverlauf der mit seinem Transplantat vor der endothelialen Dekompensation zufriedene Patient mit geringem Astigmatismus und ohne stromale Narben die optimale Voraussetzung für die DMEK nach PKP dar. Diese kann auch mit einer Phakoemulsifikation kombiniert werden (sog. Triple-DMEK). Anderenfalls erfolgt eine perforierende Re-Keratoplastik mit einem größeren Transplantat (typischerweise Excimerlaser-Re-PKP 8,5/8,6 mm), um gleichzeitig Ödem, Narben und Verkrümmung zu therapieren. Die Anamnese hat bei dieser Entscheidung Gewicht! Eine Re-DMEK bei Transplantatversagen nach DMEK und DSAEK bedarf keiner Modifikation der Standardtechnik und führt bei raschem Vorgehen zu guten Visusergebnissen. Bei eindeutiger stromaler Vernarbung nach multiplen (externen) DMEKs kann auch eine PKP zur Bereinigung der Situation erwogen werden. Bei ansonsten grundlos rezidivierenden Transplantatversagen muss man an eine herpetische oder CMV-Endotheliitis denken und nach PCR-Analyse des Kammerwasseraspirats entsprechend medikamentös therapieren.
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- 2022
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17. Corneal Perforation as a Rare and Late Manifestation of Choroidal Melanoma
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Tim Berger, Fidelis Flockerzi, Ursula Löw, Elias Flockerzi, Wissam Aljundi, Alaadin Abdin, Loay Daas, and Berthold Seitz
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Ophthalmology - Abstract
Purpose To report a case of corneal perforation as a rare and late manifestation of choroidal melanoma and to highlight the major histopathological findings of this unusual combined clinical presentation. Methods A 74-year-old male patient presented to our department due to corneal perforation of the right eye with the absence of light perception for 6 months. The intraocular pressure was hard on palpation. Because of the protracted finding and reduced visual prognosis, primary enucleation was performed. Results The histopathological examination revealed choroidal melanoma with epithelioid and spindle cell components at the posterior pole, which was positive for Melan-A, Human Melanoma Black 45 (HMB45), BAP1, and SOX10. The anterior segment showed complete anterior chamber hemorrhage and blood remnants in the trabecular meshwork. The cornea displayed diffuse blood staining with hemosiderin and hemosiderin-loaded macrophages and keratocytes. No inflammatory cells were present near the corneal perforation, which had a width of 3 mm. Intraocular heterotopic ossification was indicative of a long-standing condition. Postoperative cancer staging was normal. Conclusion Corneal perforation should be considered as a very rare and late manifestation of advanced choroidal melanoma and may result from interaction between intraocular hemorrhage, elevated IOP, and its secondary signs such as corneal blood staining.
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- 2023
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18. Unterschiedlicher Verlauf von Immunreaktionen und Endothelzellverlust nach perforierender Low-Risk-Keratoplastik und Descemet Membrane Endothelial Keratoplasty bei Fuchs-Endotheldystrophie
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Laura Katharina Jablonski, Elena Zemova, Loay Daas, Cristian Munteanu, and Berthold Seitz
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Ophthalmology - Abstract
Zusammenfassung Hintergrund Ziel der vorliegenden Studie ist es, die Häufigkeit von Immunreaktionen und den Endothelzellverlust nach perforierender Keratoplastik (PKP) vs. Descemet Membrane Endothelial Keratoplasty (DMEK) bei Patienten mit Fuchs-Endotheldystrophie (FED) gegenüberzustellen. Patienten und Methoden In der vorliegenden retrospektiven Studie wurden insgesamt 962 Operationen (OPs; 225 Excimer-Laser-PKP und 727 DMEK) von 700 Patienten, die zwischen dem 28.06.2007 und dem 27.08.2020 in der Universitäts-Augenklinik des Saarlandes durchgeführt wurden, statistisch ausgewertet. Zum einen wurde die Prävalenz und der zeitliche Verlauf der aufgetretenen Immunreaktionen mittels Kaplan-Meier-Verfahren sowie die Auswirkungen der Immunreaktionen auf die Endothelzellen und die Hornhautdicke analysiert. Zum anderen wurden Endothelzelldichte, Pleomorphismus und Polymegalismus der Endothelzellen für die Zeitpunkte U1 = präoperativ, U2 = 6 Wochen postoperativ, U3 = 6 – 9 Monate postoperativ, U4 = 1 – 2 Jahre postoperativ und U5 = 5 Jahre postoperativ ausgewertet. Weiter erfolgte dazu jeweils eine statistische Testung auf Unterschiede zwischen den beiden OP-Arten sowie im longitudinalen Verlauf. Ergebnisse Insgesamt traten im beobachteten Zeitraum 54 Immunreaktionen auf, wobei die Wahrscheinlichkeit für eine solche bei der PKP mit 8,9% signifikant größer war als in der DMEK-Gruppe mit 4,5% (p = 0,011). Der Vergleich der beiden Kaplan-Meier-Kurven ergab im Log-Rank-Test ebenfalls einen signifikanten Unterschied zwischen den beiden OP-Techniken (p = 0,012). Der Endothelzellverlust durch die Immunreaktion war nur bei der PKP signifikant (p = 0,003). Auf alle OPs bezogen sank die Endothelzelldichte bei beiden OP-Techniken signifikant mit der Zeit (jeweils p Schlussfolgerung Die Prognose der DMEK bei Patienten mit FED scheint nach Immunreaktionen günstiger zu sein als die der PKP, da nicht nur seltener Immunreaktionen auftraten, sondern diese auch milder verliefen. Die Endothelzelldichte war allerdings in der PKP-Gruppe während des gesamten Follow-ups signifikant höher.
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- 2023
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19. Morphological characterization and clinical effects of stromal alterations after intracorneal ring segment implantation in keratoconus
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Loïc Hamon, Ursula Schlötzer-Schrehardt, Fidelis A. Flockerzi, Berthold Seitz, and Loay Daas
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Corneal Stroma ,Ultrastructural changes ,Corneal Topography ,Prostheses and Implants ,Keratoconus ,Refraction, Ocular ,Fibrosis ,Intracorneal ring segments ,Sensory Systems ,Prosthesis Implantation ,Cellular and Molecular Neuroscience ,Ophthalmology ,Treatment Outcome ,Humans ,Lamellar channel deposits ,Peri-segmental fbrosis ,Retrospective Studies - Abstract
Purpose To analyze the histological and (ultra)structural stromal tissue changes after femtosecond (Fs) laser–assisted intracorneal ring segment (ICRS) implantation and their refractive and topographic effects in patients with keratoconus. Methods This monocentric retrospective case series included 15 consecutive patients with clinical peri-segmental lamellar channel deposits after treatment with Fs-ICRS implantation for keratoconus. The stromal changes were investigated using in vivo confocal microscopy. Two patients underwent a penetrating keratoplasty after the Fs-ICRS implantation; the explanted corneas were processed for histopathology and transmission electron microscopy (TEM). Refractive and topographic effects were investigated comparing the uncorrected (UDVA) and corrected (CDVA) distance visual acuity, spherical equivalent (SE), flat (K1), steep (K2), and steepest (Kmax) keratometry before and after detection of lamellar channel deposits. Results In vivo confocal microscopy revealed diffuse linear and focal granular hyperreflective structures. Histologically, there was mild proliferation of fibroblasts and fibrosis. TEM demonstrated focal accumulations of degenerated keratocytes with cytoplasmic lipid inclusions. There were no significant changes for UDVA (Δ = 0.0 ± 0.2 logMAR; p = 0.67), CDVA (Δ = 0.0 ± 0.1 logMAR; p = 0.32), SE (Δ 0.1 ± 0.9 D; p = 0.22), K1 (Δ = 0.3 ± 1.0 D; p = 0.28), K2 (Δ = 0.1 ± 0.9 D; p = 0.51), and Kmax (Δ = 0.3 ± 1.5 D; p = 0.17). Conclusions Two types of structural stromal changes were identified: (1) diffuse peri-segmental fibrosis and (2) lamellar channel deposits. These structural changes showed no evidence of a relevant refractive or topographic effect.
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- 2022
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20. Prevalence and Impact of Cornea Guttata in the Graft After Penetrating Keratoplasty in Germany
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Silvana, Schönit, Amine, Maamri, Elena, Zemova, Cristian, Munteanu, Tarek, Safi, Loay, Daas, and Berthold, Seitz
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Cornea ,Ophthalmology ,Postoperative Complications ,Treatment Outcome ,Fuchs' Endothelial Dystrophy ,Prevalence ,Humans ,Keratoplasty, Penetrating ,Retrospective Studies - Abstract
The aim of this study was to analyze the prevalence and severity of corneal guttata (CG) in grafts after penetrating keratoplasty (PKP) and to determine its clinical significance.This retrospective study included 1758 PKP performed in 1522 patients. In total, 6662 postoperative endothelial images revealed the prevalence and severity of CG (divided into categories G0 without CG and G1-G3 with increasing severity). Origin of the graft, postoperative corneal thickness, visual acuity, pleomorphism, polymegethism, and endothelial cell density (ECD) were analyzed.CG was detected in 14.9% of the grafts within 9 months after PKP, most of them were low-grade G1 (13.6%). Grafts from Homburg/Saar showed significantly less CG cases compared with other eye banks ( P = 0.034). The mean corrected distance visual acuity (logMAR) did not differ between G1 (0.45 ± 0.31) and G0 (0.46 ± 0.31). The mean ECD was lower in G1 compared with G0 ( P0.001). The mean corneal thickness was higher in G3 (597 ± 101 μm) compared with G0 (541 ± 65 μm) ( P0.001). Pleomorphism and polymegethism were correlated with CG ( P0.001). A progression of CG severity was detected in 13.5% of the cases during a follow-up time of 25.0 ± 19.9 months.Our study suggested that CG are transplanted in 14.9% of PKP, most of which are low-grade CG not affecting the visual acuity but already leading to an increase in corneal thickness, loss of ECD, and alteration of endothelial cell morphology. In 13.5% of the cases, a progression was demonstrated in the postoperative course.
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- 2022
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21. Haze nach PRK (ohne Verwendung von Mitomycin C) auf einer mit DALK und LASIK vorbehandelten Hornhaut – klinische und histopathologische Befunde
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Tarek Safi, Berthold Seitz, Elias Flockerzi, Fidelis Flockerzi, and Loay Daas
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Ophthalmology - Published
- 2021
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22. Penetrating Excimer Laser Keratoplasty with vs without the Homburg Cross-Stitch Marker in Inexperienced Surgeons
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Suffo S, El Halabi M, Seitz B, Abdin AD, Munteanu C, and Daas L
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Ophthalmology ,astigmatism ,excimer laser-assisted penetrating keratoplasty ,homburg cross-stitch marker ,hoffmann cross-stitch suture ,refractive cylinder ,RE1-994 ,corrected distance visual acuity - Abstract
Shady Suffo, Mohammed El Halabi, Berthold Seitz, Alaa Din Abdin, Cristian Munteanu, Loay Daas Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg, Saar, GermanyCorrespondence: Mohammed El HalabiDepartment of Ophthalmology, Saarland University Medical Center, Kirrberger Straße 100, Bldg. 22, Homburg, 66421, GermanyTel +491739920686Email mohammed.elhalabi@uks.euBackground and Objectives: The Homburg cross-stitch marker, according to Suffo, was developed in 2017 in the Department of Ophthalmology at Saarland University Medical Center. With this instrument, a surgeon can precisely define and mark the points of the first and second continuous cross-stitch sutures, according to Hoffmann. The aim of this retrospective study was to compare the functional outcomes of Hoffmann’s double continuous cross-stitch suture in penetrating keratoplasty (PKP) with vs without the Homburg cross-stitch marker in inexperienced surgeons.Methods: A total of 130 eyes from 130 patients with central corneal scars, corneal dystrophies and advanced keratoconus were included. All eyes underwent elective excimer laser-assisted penetrating keratoplasty (excimer laser PKP) with a diameter of 8.0/8.1mm. In 65 eyes each, surgery was performed without (group 1) or with (group 2) the Homburg cross-stitch marker. Corrected distance visual acuity, topographic astigmatism, and refractive cylinder were obtained 6 weeks, 10 months post-PKP as well as 6 weeks after the first and after the second suture removal, respectively. The rate of early postoperative single interrupted suture addition was compared between the two groups.Results: Visual acuity, astigmatism and refractive cylinder values were significantly more favorable in group 2 (with device) compared to group 1 (without device) before and after suture removal. Postoperative single interrupted suture addition was performed in 34.4% of patients in group 1 compared to 10.6% in group 2 (P = 0.001, Fisher’s Exact Test).Conclusion: The use of the Homburg cross-stitch marker for excimer laser PKP in young cornea specialists results in significantly better visual acuity before and after suture removal, significantly lower astigmatism and cylinder value before suture removal, as well as a reduced necessity of early postoperative single interrupted suture addition.Keywords: excimer laser-assisted penetrating keratoplasty, Hoffmann cross-stitch suture, Homburg cross-stitch marker, corrected distance visual acuity, astigmatism, refractive cylinder
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- 2021
23. Non-invasive endothelial cell density measurement of in toto pre-stripped DMEK-roll – impact of pre- and intraoperative endothelial cell loss on postoperative midterm clinical outcome
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Kolja Berg, Tarek Safi, Berthold Seitz, and Loay Daas
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Ophthalmology ,Corneal diseases ,Outcomes research - Published
- 2023
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24. Impact of implementation of polymerase chain reaction on diagnosis, treatment, and clinical course of Acanthamoeba keratitis
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Mathias Roth, Adriana Balasiu, Loay Daas, Christoph Holtmann, Anna Servera, Marcus Walckling, Colin R. MacKenzie, Thomas A. Fuchsluger, and Gerd Geerling
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Cellular and Molecular Neuroscience ,Ophthalmology ,Sensory Systems - Abstract
Purpose Acanthamoeba keratitis (AK) is a painful and possibly sight-threatening ocular infection. While the correct diagnosis and specific treatment in the early stages significantly improve the prognosis, the disease is often misdiagnosed and in clinical examination confused with other forms of keratitis. Polymerase chain reaction (PCR) for the detection of AK was first introduced in our institution in December 2013 to improve the timely diagnosis of AK. The aim of this study was to assess the impact of implementation of Acanthamoeba PCR on the diagnosis and treatment of the disease in a German tertiary referral center. Patients and methods Patients treated for Acanthamoeba keratitis between 1st of January 1993 and 31st of December 2021 in the Department of Ophthalmology of the University Hospital Duesseldorf were identified retrospectively via in-house registries. Evaluated parameters include age, sex, initial diagnosis, method of correct diagnosis, duration of symptoms until correct diagnosis, contact lens use, visual acuity, and clinical findings as well as medical and surgical therapy by keratoplasty (pKP). In order to assess the impact of implementation of Acanthamoeba PCR, the cases were divided into two groups (before (pre-PCR group) and after PCR implementation (PCR group). Results Seventy-five patients with Acanthamoeba keratitis were included (69.3% female, median age 37 years). Eighty-four percent (63/75) of all patients were contact lens wearers. Until PCR was available, 58 patients with Acanthamoeba keratitis were diagnosed either clinically (n = 28), by histology (n = 21), culture (n = 6), or confocal microscopy (n = 2) with a median duration until diagnosis of 68 (18; 109) days. After PCR implementation, in 17 patients, the diagnosis was established with PCR in 94% (n = 16) and median duration until diagnosis was significantly shorter with 15 (10; 30.5) days. A longer duration until correct diagnosis correlated with a worse initial visual acuity (p = 0.0019, r = 0.363). The number of pKP performed was significantly lower in the PCR group (5/17; 29.4%) than in the pre-PCR group (35/58; 60.3%) (p = 0.025). Conclusions The choice of diagnostic method and especially the application of PCR have a significant impact on the time to diagnosis and on the clinical findings at the time of confirmation of diagnosis and the need for penetrating keratoplasty. In contact lens–associated keratitis, the first crucial step is to take AK into consideration and perform a PCR test as timely confirmation of diagnosis of AK is imperative to prevent long-term ocular morbidity.
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- 2023
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25. Outcomes of Severe Fungal Keratitis Using in vivo Confocal Microscopy and Early Therapeutic Penetrating Keratoplasty
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Chrysovalantis Sourlis, Berthold Seitz, Mathias Roth, Loïc Hamon, and Loay Daas
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Ophthalmology ,fungal keratitis ,Clinical Ophthalmology ,penetrating keratoplasty ,in vivo confocal microscopy - Abstract
Chrysovalantis Sourlis,1 Berthold Seitz,1 Mathias Roth,2 Loïc Hamon,1 Loay Daas1 1Department of Ophthalmology, Saarland University Medical Center, UKS, Homburg/Saar, Germany; 2Department of Ophthalmology, Heinrich-Heine University Düsseldorf, Düsseldorf, GermanyCorrespondence: Loïc Hamon, Department of Ophthalmology, Saarland University Medical Center, UKS, Homburg/Saar, Germany, Tel +49-6841-1622387, Fax +49-6841-1622400, Email loic.hamon@uks.euPurpose: The purpose of this study was to assess the impact of early diagnosis using in vivo confocal microscopy and early therapeutic penetrating keratoplasty (TPK) on the outcomes of severe cases of fungal keratitis.Methods: This retrospective single-center study included 38 patients (40 eyes) with fungal keratitis who presented between December 2013 and February 2020. Preoperative, intraoperative, and postoperative parameters were recorded to assess the role of early correct diagnosis and early surgical therapy on visual acuity outcome and enucleation rate during follow-up.Results: The mean patient age was 51 years (71% females). The initial external diagnosis was correct in 20 cases (50%). The mean time from symptom onset until admission to our department was 46.8 ± 68.0 (median 28.5) days. The mean time to correct diagnosis after admission to our department was 1 day with in vivo confocal microscopy (IVCM). IVCM was performed in 38 cases, of which 36 (sensitivity: 94.7%) were positive for fungal infection. Twenty-seven out of 40 (67.5%) eyes received a TPK 4.2 ± 3.9 days after admission, with a mean graft size of 8.9 ± 1.9 mm. Three eyes (7.5%) were enucleated. The corrected distance visual acuity of the entire study population increased from 2.0 ± 1.2 LogMAR to 0.96 ± 1.17 LogMAR.Conclusion: In vivo confocal microscopy is a powerful tool for the early detection of fungal organisms in infectious keratitis. An early TPK with a large graft helps to eradicate the infection timely and results in a favorable visual acuity outcome and lower enucleation rate, especially when treating filamentous fungi.Keywords: fungal keratitis, in vivo confocal microscopy, penetrating keratoplasty
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- 2023
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26. Infectious Crystalline Keratopathy after Penetrating Keratoplasty with Light and Electron Microscopic Examination
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Tim Berger, Berthold Seitz, Max Bofferding, Fidelis Flockerzi, Ursula Schlötzer-Schrehardt, and Loay Daas
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Ophthalmology - Abstract
To highlight the typical histological and ultrastructural features of severe infectious crystalline keratopathy (ICK) in a corneal graft, which required excimer laser-assisted repeat penetrating keratoplasty (PKP) and to present the challenging treatment conditions associated with ICK.An 85-year-old female patient underwent PKP for secondary graft failure after Descemet membrane endothelial keratoplasty (DMEK) for Fuchs' endothelial corneal dystrophy in the left eye. One year later, white branched opacities were observed in the superficial corneal stroma of the graft without surrounding inflammation in the left eye. The patient underwent excimer laser-assisted repeat PKP (8.0/8.1 mm) in the left eye after prolonged refractory topical anti-infectious treatment for 1 month. The corneal explant was further examined by light and transmission electron microscopy (TEM).The light microscopic examination of the corneal explant demonstrated aggregates of coccoid bacteria in the superficial and mid-stromal region that were positive for periodic acid-Schiff (PAS) and Gram stain. The bacterial aggregates extended into the interlamellar spaces, showed a spindle-shaped appearance, and were not surrounded by an inflammatory cellular reaction. TEM demonstrated lamellae separation within the anterior corneal stroma with spindle-shaped aggregates of bacteria, which were embedded in an extracellular amorphous matrix with incipient calcification, being consistent with a biofilm. No inflammatory cellular reaction was evident by TEM. At discharge from hospital, the corrected visual acuity was 20/80 in the left eye.ICK is often challenging due to the difficult diagnosis and treatment conditions. The refractory courses are mainly attributed to a biofilm formation, which inhibits effective topical anti-infectious treatment. In such cases, (repeat) PKP may be necessary to completely remove the pathology, prevent recurrences, and improve vision.Darstellung der typischen histologischen und ultrastrukturellen Merkmale und die schwierigen Behandlungsbedingungen einer schweren infektiösen kristallinen Keratopathie (ICK).Eine 85-jährige Patientin unterzog sich einer perforierenden Keratoplastik (PKP) aufgrund sekundären Transplantatversagens nach einer Descemet-Membran-Endothel-Keratoplastik (DMEK) bei Fuchsʼscher endothelialer Hornhautdystrophie am linken Auge. Ein Jahr später wurden weiße verzweigte Trübungen im oberflächlichen Hornhautstroma des Transplantats ohne umgebende Entzündung am linken Auge beobachtet. Die Patientin unterzog sich einer erneuten Excimer-Laser-unterstützten PKP (8,0/8,1 mm) am linken Auge, nachdem die topische antiinfektiöse Behandlung zu keiner Besserung nach einem Monat führte. Das Hornhautexplantat wurde mittels Licht- und Transmissionselektronenmikroskopie (TEM) untersucht.Die lichtmikroskopische Untersuchung des Hornhautexplantats zeigte Aggregate von kokkoiden Bakterien im oberflächlichen und mittleren Stromabereich, die positiv in der PAS-Reaktion und Gram-Färbung waren. Die Bakterienaggregate erstreckten sich bis in die interlamellären Räume, zeigten ein spindelförmiges Aussehen und waren nicht von einer entzündlichen Zellreaktion umgeben. Die TEM zeigte eine Lamellenseparation im vorderen Hornhautstroma mit spindelförmigen Bakterienaggregaten, die in eine extrazelluläre amorphe Matrix mit beginnender Verkalkung eingebettet waren, was auf einen Biofilm schließen lässt. In der TEM war keine entzündliche zelluläre Reaktion erkennbar. Bei der Entlassung betrug die korrigierte Sehschärfe 20/80 auf dem linken Auge.Die ICK stellt aufgrund der schwierigen Diagnose- und Behandlungsbedingungen häufig eine Herausforderung dar. Die therapierefraktären Verläufe werden hauptsächlich auf eine Biofilmbildung zurückgeführt, die eine wirksame topische antiinfektiöse Behandlung verhindert. In solchen Fällen kann eine (Re-)PKP erforderlich sein, um die Pathologie vollständig zu entfernen, Rezidive zu verhindern und das Sehvermögen zu verbessern.
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- 2022
27. Mycotic keratitis – Experience in Europe
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Loay Daas, C. Sourlis L. Hamon, and B. Seitz
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Ophthalmology ,General Medicine - Published
- 2022
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28. Intracorneal ring segments for <scp>KC</scp> and iatrogenic keratectasia
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Loay Daas, L. Hamon, E. Flockerzi, and B. Seitz
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Ophthalmology ,General Medicine - Published
- 2022
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29. Biomechanical effect of intracorneal ring segment implantation
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Loïc Hamon, Luisa J. Pfahl, Elias Flockerzi, Tim Berger, Achim Langenbucher, Berthold Seitz, and Loay Daas
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Ophthalmology ,General Medicine - Published
- 2022
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30. Traumatische Zyklodialyse – von der Zyklopexie ab interno bis zur DMEK: ein Fallbericht
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Shady Suffo, Tim Berger, Cristina Martin, Berthold Seitz, and Loay Daas
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Gynecology ,Ophthalmology ,medicine.medical_specialty ,business.industry ,Medicine ,business - Published
- 2021
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31. Phacoemulsification combined with micropulse cyclodiode laser in glaucoma patients: efficacy and safety
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Thomas Sherman, Ayesha Karimi, Lina Danieliute, Kin Sheng Lim, Saurabh Goyal, Arij Daas, Ian A Rodrigues, and Andrew Amon
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Adult ,medicine.medical_specialty ,Intraocular pressure ,Visual acuity ,genetic structures ,medicine.medical_treatment ,Glaucoma ,Cataract ,Ophthalmology ,Humans ,Medicine ,Intraocular Pressure ,Retrospective Studies ,Phacoemulsification ,Laser Coagulation ,Adult patients ,business.industry ,General Arts and Humanities ,Ciliary Body ,Cataract surgery ,medicine.disease ,eye diseases ,Sensory Systems ,Treatment Outcome ,Lasers, Semiconductor ,medicine.symptom ,business - Abstract
Objective To evaluate the safety and efficacy of phacoemulsification combined with Micropulse transscleral cyclophotocoagulation (MP-TSCPC) in glaucoma patients. Methods This is a retrospective case-note review. The participants were adult patients with diagnoses of glaucoma and cataract who required a further reduction in IOP or a reduction in the number of glaucoma drops. All consecutive patients who underwent cataract surgery (CS) combined with MP-TSCPC laser between October 2018 and July 2019 were included in the study. The effect on visual acuity (VA), intraocular pressure (IOP) and number of anti-glaucoma drops were evaluated at 6 and 12 months in addition to any complications that occurred during any time point of the study. Results 42 eyes were included in the study. Mean IOP was reduced from 19.5 ± 5.4 mmHg by 22.5% to 15.1 ± 4.6 at 6 months post-operatively and by 19.5% to 15 ± 6.6 mm Hg at 12 months (p p Conclusion This is the first study evaluating the effect of cataract surgery combined with MP-TSCPC in glaucoma patients. We demonstrated that this led to a reduction in IOP and the number of anti-glaucoma medications at 6 and 12-month postoperatively. The majority of patients had either stable or better vision at 12 months follow-up.
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- 2021
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32. Partielle visuelle Rehabilitation 5 und 6 Jahre nach totaler Bindehautdeckung mittels Gundersen-Flap
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Fidelis A. Flockerzi, Loay Daas, Berthold Seitz, and Y Abu Dail
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medicine.medical_specialty ,Intraocular pressure ,Visual acuity ,genetic structures ,business.industry ,medicine.medical_treatment ,Perforation (oil well) ,Intraocular lens ,Cataract surgery ,corneal ulcer ,medicine.disease ,eye diseases ,Transplantation ,Ophthalmology ,Trephine ,medicine ,sense organs ,medicine.symptom ,business - Abstract
Background We present the results of penetrating keratoplasty (PKP) after previous treatment with a total conjunctival flap in two patients. Case reports Patient 1, a 66-year-old with a history of bilateral cement chemical burn in 1986 and external right-sided limbokeratoplasty in 2008 was treated externally with a total conjunctival flap in the right eye in 2014 due to a persistent corneal ulcer with imminent perforation. Best-corrected visual acuity (BCVA) in the right eye was light sensation, intraocular pressure on palpation was within normal range. Clinically, total conjunctival flap was present. Patient 2 was treated externally in May 2015 due to acanthamoeba keratitis in the left eye with a deep anterior lamellar keratoplasty (DALK). A re-DALK was also performed externally in the same month. A third DALK was performed externally in August 2015 due to a persistent corneal ulcer, followed by a total conjunctival flap 2 weeks later. BCVA of the left eye was light sensation and intraocular pressure on palpation was within the normal range. Results Patient 1 was treated with removal of the conjunctival flap in the right eye and penetrating central re-keratoplasty (hand-held Barron trephine; graft diameter 8.5/8.75 mm). Simultaneously, lens extraction and intraocular lens implantation were performed (as a triple procedure). Additionally, amniotic membrane transplantation (AMT) as patch and a temporal lateral tarsorrhaphy were performed. BCVA 6 months postoperatively was 0.1. The graft was clear, without any signs of rejection. Patient 2 was treated on the left eye with removal of the conjunctival flap and a penetrating central keratoplasty (hand-held Barron trephine; graft diameter 7.0/7.5 mm). An AMT as patch and a temporal lateral tarsorrhaphy were simultaneously performed. Cataract surgery was performed 3 months postoperatively and BCVA of the right eye was 0.1 thereafter. The graft was clear, without any signs of rejection. Conclusion The conjunctival flap is a treatment of last resort of the (almost) penetrated corneal ulcer, which is to be used only when a keratoplasty is technically impossible. Provided the eye structure and retinal function are preserved, partial visual rehabilitation can possibly be achieved through a PKP after excision of the conjunctival flap, even years after corneal blindness.
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- 2021
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33. Successful Bilateral Exchange of Multifocal IOLs 7 Years after Cataract Surgery due to Patient Dissatisfaction
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Ibrahim Qozat, Loay Daas, Sabine Lepper, and Berthold Seitz
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Ophthalmology ,medicine.medical_specialty ,business.industry ,MEDLINE ,Medicine ,Multifocal IOLs ,After cataract ,business ,Surgery - Published
- 2021
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34. Accelerated Corneal Crosslinking for Treatment of Keratoconus in Children and Adolescents under 18 Years of Age
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Kassandra Xanthopoulou, Georgia Milioti, Loay Daas, Cristian Munteanu, Berthold Seitz, and Elias Flockerzi
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Ophthalmology - Abstract
Purpose To evaluate the efficacy of accelerated (9 mW/cm2, 10 min) epithelium-off (epi-off) corneal crosslinking (A-CXL) in keratoconus (KC) patients Patients and Methods Our retrospective study included 41 eyes (25 male and 5 female patients, mean age 15.3 ± 1.2 years) who underwent A-CXL (9 mW/cm2, 10 min) because of progressive KC or critical KC at first presentation or asymmetrical finding in the partner eye. Outcome measures were best-corrected visual acuity (BCVA) and tomography readings (Pentacam HR, Oculus, Wetzlar, Germany), evaluated 2 years, 1 year, 6 months preoperatively, prior to surgery (pre-CXL) and 6 weeks, 6 months, 1 year, 2 years, > 2 years postoperatively (post-CXL). The demarcation line was assessed by anterior segment optical coherence tomography (SS-1000 and CASIA 2, Tomey, Nagoya, Japan). Results Total deviation value increased statistically significantly 6 months pre-CXL to pre-CXL. Anterior steep, flat, and mean keratometry values showed a statistically significant increase 6 weeks post-CXL (p 2 years post-CXL (p 2 years post-CXL (p > 0.05). BCVA decreased 6 weeks post-CXL but improved significantly > 2 years post-CXL (p = 0.003). The demarcation line reached an average depth of 52.1%. Conclusions Epi-off A-CXL stabilizes KC progression in patients 2 years postoperatively and leads to a deep demarcation line. A “pseudoprogression” is observed up to the 6-week follow-up, which is not indicative of the long-term results.
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- 2022
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35. <scp>DMEK</scp> outcome after one year – Results from a large multicenter study in Germany
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Kristina Spaniol, Martin Hellmich, Klara Borgardts, Christian Girbardt, Philip Maier, Thomas Reinhard, Necip Torun, Anna‐Karina Maier, Sebastian Thaler, Karl U. Bartz‐Schmidt, Peter Wiedemann, Berthold Seitz, Loay Daas, Silvia Schrittenlocher, Claus Cursiefen, Björn Bachmann, and Gerd Geerling
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Ophthalmology ,General Medicine - Abstract
Descemet membrane endothelial keratoplasty (DMEK) accounts for50% of all corneal transplants in Germany. So far, no data from such a large multicenter study have been published.This retrospective study included 3200 DMEKs at seven departments performed for Fuchs endothelial corneal dystrophy (FECD) or bullous keratopathy (BK). We evaluated best corrected visual acuity (BCVA, logMAR), endothelial cell density (ECD, cells/mmFor patients without vision-limiting comorbidities (74% of all analysed eyes, n = 2270), mean BCVA improved from 0.6 ± 0.4 logMAR to 0.2 ± 0.2 logMAR 6 months (p 0.001, n = 1441) and 0.1 ± 0.2 logMAR 12 months (p = 0.001, n = 1402) postoperatively. BK- had a worse BCVA compared to FECD-patients (0.3 ± 0.5 vs. 0.1 ± 0.2 logMAR [p 0.001] at 1 year). ECD declined from 2465 ± 259 cells/mmDescemet membrane endothelial keratoplasty increases visual acuity with low transplant failure- and rejection-rates. FECD has a better outcome than BK. Since a quarter of all patients need a rebubbling, this should be included in the informed consent. Remarkably, one rebubbling has no influence on the outcome.
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- 2022
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36. Kombinierte transepitheliale PTK und topografiegesteuerte PRK zur Behandlung von traumatisch bedingten Hornhautnarben
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Tom Müller, Klemens Paul Kaiser, Yosuf El-Shabrawi, Loay Daas, Elfriede Wissiak, and Navid Ardjomand
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Gynecology ,Ophthalmology ,medicine.medical_specialty ,business.industry ,medicine ,business ,Corneal scarring - Abstract
Hornhautnarben konnen die Sehleistung stark beeintrachtigen und zudem in der Behandlung sehr schwierig sein. Das Ziel dieser Studie war eine minimal-invasive Moglichkeit in der Therapie von kornealen Narben zu evaluieren und die Ergebnisse zu prasentieren. In diese retrospektive, interventionelle Studie wurden 4 Augen von 4 Patienten inkludiert, die in Folge eines Traumas eine Hornhautnarbe und irregulare Oberflache entwickelten. Diese wurden zwischen 2017 und 2020 mit einer topografiegesteuerten photorefraktiven Keratektomie (TG-PRK) behandelt. Das Abtragungsprofil wurde bei allen 4 Fallen mit dem CRS-Master (Zeiss, Jena, Deutschland) berechnet. Die Hauptzielgrosen waren der unkorrigierte und bestkorrigierte Fernvisus, die manifeste Refraktion und die korneale Regularitat durch topografische Aufnahmen. Das mittlere Alter betrug 34,75 ± 15,39 Jahre und die Nachbeobachtungszeit 6 Monate bei allen Patienten. In 3 Fallen wurde die volle subjektive Refraktion in einer Sitzung korrigiert. Ein Patient hatte eine Fehlsichtigkeit von +0,5 dpt. In diesem Fall wurde nur eine Glattung ohne zusatzliche Korrektur der Refraktion durchgefuhrt. Alle 4 Patienten zeigten eine Verbesserung des unkorrigierten (2 bis 3 Zeilen) und korrigierten (3 Zeilen) Fernvisus. Es traten keine Komplikationen wahrend und nach den Behandlungen auf, und es kam bei keinem Fall zu einer Reduktion der Sehscharfe. Mittels TG-PRK kann bei Patienten mit traumatischen kornealen Narben eine Verbesserung der Sehscharfe erreicht werden. Bei myopen Patienten kann in einer Sitzung auch der Grosteil der Fehlsichtigkeit korrigiert werden.
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- 2021
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37. Stadiengerechte Therapie des Keratokonus
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S Razafimino, C. Spira-Eppig, Elias Flockerzi, Loïc Hamon, Loay Daas, K. Xanthopoulou, S. Goebels, Nóra Szentmáry, Berthold Seitz, and Achim Langenbucher
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Keratoconus ,medicine.medical_specialty ,Visual Acuity ,Perforierende Keratoplastik ,Intracorneal ring segments ,Cornea ,ABCD-Grading-System ,CME ,Medicine ,Humans ,Riboflavin-UVA-Crosslinking ,Contact lenses ,Kontaktlinsen ,Riboflavin UVA cross-linking ,Gynecology ,business.industry ,Intrastromale Ringsegmente ,medicine.disease ,ABCD grading system ,Causality ,Ophthalmology ,Deep lamellar keratoplasty ,Tiefe lamelläre Keratoplastik ,business ,Keratoplasty, Penetrating ,Penetrating keratoplasty - Abstract
Keratoconus (KC) is a progressive cone-shaped corneal protrusion that causes paracentral thinning at the apex of the cone and typically occurs asymmetrically on both sides. After a careful anamnesis and classification of the degree of severity a targeted treatment appropriate to the stage of the disease is available. If the visual acuity is no longer sufficient, rigid gas-permeable contact lenses (CL) are fitted by a specialist. Riboflavin UVA cross-linking (CXL) is recommended in cases of progression and visual acuity that is still useful for the patient. Intracorneal ring segments (ICRS) are indicated for CL intolerance in cases of reduced visual acuity and a clear central cornea. If the stage is more advanced, deep anterior lamellar keratoplasty (DALK) or penetrating keratoplasty (PKP) is recommended. A PKP is contraindicated in acute KC but deep stromal sutures for readaptation of the Descemet tear with gas filling of the anterior chamber can considerably shorten the course. Almost no other eye disease is nowadays as easily accessible for an early instrument-based diagnosis and stage-appropriate treatment as KC.Der Keratokonus (KK) ist eine progrediente kegelförmige Hornhautvorwölbung, die eine parazentrale Verdünnung an der Kegelspitze verursacht und typischerweise beidseitig asymmetrisch auftritt. Nach einer sorgfältigen Anamnese und Einstufung des Schweregrades steht heute eine gezielte stadiengerechte Therapie zur Verfügung. Ist der Brillenvisus nicht mehr ausreichend, werden von einem Spezialisten formstabile sauerstoffdurchlässige Kontaktlinsen (KL) angepasst. Bei Progression und für den Patienten im Alltag nutzbarem Visus empfiehlt sich das Riboflavin-UVA-Crosslinking (CXL), bei herabgesetztem Visus und klarer zentraler Hornhaut sind bei KL-Intoleranz intrastromale Ringsegmente (ICRS) indiziert. Ist das Stadium weiter fortgeschritten, empfiehlt sich die tiefe anteriore lamelläre (DALK) oder perforierende Keratoplastik (PKP). Bei einem akuten Keratokonus ist die PKP kontraindiziert, allerdings verkürzen tiefstromale Nähte zur Readaptation des Descemet-Risses mit Gasfüllung der Vorderkammer den Verlauf erheblich. Fast keine andere Augenerkrankung ist heutzutage einer frühen apparativen Diagnose und stadiengerechten Therapie so gut zugänglich wie der KK.
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- 2021
38. Efficacy, safety, and predictability of transepithelial photorefractive keratectomy: meta-analysis
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Stefan Wagenpfeil, Navid Ardjomand, Achim Langenbucher, Elias Flockerzi, Alexandra Sabau, Abdelshafi Behkit, Berthold Seitz, and Loay Daas
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medicine.medical_specialty ,medicine.medical_treatment ,Visual Acuity ,MEDLINE ,Astigmatism ,Refraction, Ocular ,Photorefractive Keratectomy ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Germany ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Predictability ,Prospective cohort study ,Retrospective Studies ,business.industry ,medicine.disease ,Sensory Systems ,Photorefractive keratectomy ,Confidence interval ,Ophthalmology ,Treatment Outcome ,Meta-analysis ,030221 ophthalmology & optometry ,Lasers, Excimer ,Surgery ,business ,030217 neurology & neurosurgery - Abstract
Purpose The aim of this study was to evaluate the efficacy, safety and predictability of transepithelial photorefractive keratectomy (TransPRK) for correcting myopia, astigmatism and hyperopia. Setting Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany DESIGN:: Meta-analysis of retrospective or prospective studies METHODS:: Relevant studies were collected from Medline and included when meeting the following predefined criteria: randomized controlled trials, at least one of main outcome measures efficacy, safety or predictability and one common TRPK laser ("Schwind Amaris"). The parameters estimates and 95% confidence intervals (CI) were derived from random-effects meta-analysis to account for possible heterogeneity. Results Since hyperopia studies did not meet the inclusion criteria, the results are centered around myopia and astigmatism. Sixteen studies with a total of 1,924 treated eyes were included in the meta-analysis. The mean efficacy, safety and predictability had a probability of 94% CI=0.86-0.97, 0% CI= 0.00-0.03 and 89% CI=0.82-0.93, respectively. The mean correction index, difference vector and index of success had a value of 1.01 CI=1.01-1.02, 0.2 CI=0.06-0.34 and 0.12 CI=0.07-0.18, respectively. Conclusion This summary estimate shows that the TransPRK is highly effective, safe and predictable in correcting myopia and/or astigmatism.
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- 2021
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39. Large-Diameter Penetrating Keratoplasties are Mostly Due to Very Severe Infectious Keratitis and Cannot Always Prevent Secondary Enucleation
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Raul Alfaro Rangel, Achim Langenbucher, Sabine Lepper, Berthold Seitz, Georgia Milioti, Nóra Szentmáry, and Loay Daas
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Adult ,Intraocular pressure ,medicine.medical_specialty ,Visual acuity ,genetic structures ,Enucleation ,Visual Acuity ,Infectious Keratitis ,Corneal Diseases ,Keratitis ,Cornea ,medicine ,Humans ,Aged ,Retrospective Studies ,Aged, 80 and over ,Corneal Decompensation ,business.industry ,Graft Survival ,Middle Aged ,medicine.disease ,eye diseases ,Surgery ,Ophthalmology ,Treatment Outcome ,medicine.anatomical_structure ,medicine.symptom ,business ,Keratoplasty, Penetrating - Abstract
To report the indications and outcomes of penetrating keratoplasties with a graft diameter 8.5 mm in severe corneal diseases at the Department of Ophthalmology at Saarland University Medical Centre.Retrospective (6 years), descriptive, and observational.Thirty-five large-diameter penetrating keratoplasties (LDPKPs) in 27 patients (mean age, 62 ± 22 years) were performed from March 2010 to December 2016. The indication for surgery, number of previous corneal transplantations, best-corrected visual acuity (BCVA) before surgery, intraocular pressure, graft status, and BCVA at last follow-up were recorded.Infectious keratitis represented 83% of the indications (of those, 45% fungal). The mean corneal graft diameter was 10.8 ± 1.7 (min 8.75, max 15.0) mm. Twenty-three eyes (65% absolute) had at least one previous penetrating keratoplasty (mean graft size, 9.2 ± 1.6 mm). The mean pre-surgery BCVA was 1.96 ± 0.23 logMAR. With a mean follow-up period of 20.2 ± 13.4 months, the mean BCVA was 1.57 ± 0.57 logMAR at last follow-up. Overall, 12 grafts (35%) remained clear until the last follow-up, and in 23 grafts (65%), the primary disease recurred, or corneal decompensation developed. Up to the last follow-up, 6 eyes (17%) had to be enucleated.In complex cases of infectious keratitis requiring a LDPKP to remove the complete pathology and preserve eye integrity, the visual outcomes are generally expected to be poor, not only because of the well-known risks of LDPKP but also because of the consequences of the infectious disease itself. This knowledge is important for adequate counselling of the patient preoperatively.ZIEL: Bericht über Indikationen und Ergebnisse von perforierenden Keratoplastiken mit Transplantatdurchmesser 8,5 mm bei schweren Hornhauterkrankungen an der Klinik für Augenheilkunde des Universitätsklinikums des Saarlandes.Retrospektive (6 Jahre) und deskriptive Beobachtungsstudie.Von März 2010 bis Dezember 2016 wurden 35 „Large-Diameter perforierende Keratoplastiken“ (LDPKPs) bei 27 Patienten (mittleres Alter 62 ± 22 Jahre) durchgeführt. Erfasst wurden die Indikation zur Operation, die Anzahl der vorausgegangenen Hornhauttransplantationen, der bestkorrigierte Visus (BCVA) vor der Operation, der Augeninnendruck, der Transplantatstatus und der BCVA beim letzten Follow-up.Die infektiöse Keratitis machte 83% der Indikationen aus (davon 45% Pilzkeratitis). Der mittlere Durchmesser des Hornhauttransplantats betrug 10,8 ± 1,7 mm (mind. 8,75, max. 15,0 mm). 21 Augen (65% absolut) hatten mindestens eine vorangegangene perforierende Keratoplastik (mittlere Transplantatgröße 9,2 ± 1,6 mm). Der mittlere BCVA vor der Operation betrug 1,96 ± 0,23 logMAR. Bei einer mittleren Nachbeobachtungszeit von 20,2 ± 13,4 Monaten betrug der mittlere BCVA beim letzten Follow-up 1,57 ± 0,57 logMAR. Insgesamt blieben 12 Transplantate (35%) bis zur letzten Nachuntersuchung klar und bei 23 Transplantaten (65%) trat die primäre Erkrankung erneut auf oder es entwickelte sich eine Hornhautdekompensation. Bis zum Ende des Beobachtungszeitraums mussten 6 Augen (17%) enukleiert werden.Bei komplexen Fällen von infektiöser Keratitis, die eine LDPKP erfordern, um die gesamte Pathologie zu entfernen und die Integrität des Auges zu erhalten, sind die zu erwartenden Visusergebnisse im Allgemeinen eher ungünstig, nicht nur wegen der bekannten Risiken der LDPKP, sondern auch wegen der Folgen der Infektionskrankheit selbst. Dieses Wissen ist wichtig für eine adäquate Beratung und Aufklärung der Patienten präoperativ.
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- 2021
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40. Endothelial Cell Density and Central Corneal Thickness following Penetrating Keratoplasty of Acanthamoeba Keratitis Patients – A Retrospective Cross-Sectional Observational Study
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Lei Shi, Fabian Norbert Fries, Kassandra Xanthopoulou, Tanja Stachon, Loay Daas, Elena Zemova, Achim Langenbucher, Berthold Seitz, and Nóra Szentmáry
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Male ,030213 general clinical medicine ,03 medical and health sciences ,Ophthalmology ,Cross-Sectional Studies ,0302 clinical medicine ,Acanthamoeba Keratitis ,030221 ophthalmology & optometry ,Endothelial Cells ,Humans ,Prospective Studies ,Keratoplasty, Penetrating ,Retrospective Studies - Abstract
To analyze endothelial cell density (ECD) and central corneal thickness (CCT) following penetrating keratoplasty (PKP) inIn this retrospective, clinical, single-center, cross-sectional, observational study, patients were enrolled who underwent PKP at the Department of Ophthalmology of Saarland University Medical Center, Homburg/Saar, Germany between May 2008 and December 2016 with the diagnosis of AK. In all, 33 eyes of 33 patients (14 males, 42%) were enrolled; their mean age at the time of surgery was 39.5 ± 14.3 years. Postoperatively, AK patients received topical polyhexamethylene biguanide, propamidine isethionate, neomycin sulphate/gramicidin/polymixin B sulfate, and prednisolone acetate eye drops (5 ×/day each), and the topical treatment was tapered sequentially with 1 drop every 6 weeks over 6 months. CCT was recorded using Pentacam HR Scheimpflug tomography and ECD with the EM-3000 specular microscope before surgery and 3 and 6 months after surgery as well as after the first and second (complete) suture removal.ECD tended to decrease significantly from the time point before surgery (2232 ± 296 cells/mmIn AK, endothelial cell loss does not seem to be accelerated following PKP, despite the postoperative use of diamidine and biguanide. A subsequent prospective comparative study should confirm our retrospective longitudinal analysis.Analyse der Endothelzelldichte (ECD) und der zentralen Hornhautdicke (CCT) nach perforierender Keratoplastik bei Patienten mit Akanthamöbenkeratitis (AK).In dieser retrospektiven, klinischen, monozentrischen, observativen Querschnittsstudie wurden die Patienten, die sich zwischen Mai 2008 und Dezember 2016 an der Augenklinik des Universitätsklinikums des Saarlandes in Homburg/Saar, Deutschland, mit der Diagnose einer Akanthamöbenkeratitis einer PKP unterzogen hatten, eingeschlossen. Insgesamt wurden 33 Augen von 33 Patienten (14 Männer, 42%) eingeschlossen, das Alter zum Zeitpunkt der Operation betrug 39,5 ± 14,3 Jahre. Postoperativ erhielten die AK-Patienten topisches Polyhexamethylenbiguanid, Propamidin-Isethionat, Neomycinsulfat/Gramicidin/Polymyxin-B-Sulfat und Prednisolonacetat als Augentropfen (jeweils 5 ×/Tag), wobei die topische Behandlung sequenziell um 1 Tropfen alle 6 Wochen über 6 Monate ausgeschlichen wurde. Die CCT wurde unter Verwendung der Pentacam-HR-Scheimpflug-Tomografie, die ECD mit dem EM-3000-Spiegelmikroskop jeweils vor der Operation sowie 3 und 6 Monate nach der Operation und nach der 1. und 2. (vollständigen) Fadenentfernung erfasst.Die ECD zeigte eine abnehmende Tendenz vom Zeitpunkt vor der Operation (2232 ± 296 Zellen/mmBei der Akanthamöbenkeratitis scheint der Endothelzellverlust nach PKP trotz der postoperativen Anwendung von Diamidin und Biguanid nicht beschleunigt zu sein. Eine nachfolgende prospektive Vergleichsstudie sollte unsere retrospektive Längsschnittanalyse bestätigen.
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- 2021
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41. Tomographically normal partner eye in very asymmetrical corneal ectasia: biomechanical analysis
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Shady Suffo, Timo Eppig, Loïc Hamon, Loay Daas, Doris Fraenkel, Elias Flockerzi, and Berthold Seitz
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Keratoconus ,medicine.medical_specialty ,genetic structures ,Cornea ,03 medical and health sciences ,Corneal ectasia ,0302 clinical medicine ,Corneal surgery ,Germany ,Ophthalmology ,medicine ,Humans ,University medical ,In patient ,Pentacam hr ,Normal control ,Pathological ,Retrospective Studies ,business.industry ,Corneal Topography ,medicine.disease ,Elasticity ,eye diseases ,Sensory Systems ,Biomechanical Phenomena ,030221 ophthalmology & optometry ,Surgery ,sense organs ,business ,030217 neurology & neurosurgery ,Dilatation, Pathologic - Abstract
PURPOSE To point out the biomechanical changes of the topographically and tomographically normal partner eye (NPE) in patients with very asymmetrical corneal ectasia. SETTING Department of Ophthalmology, Saarland University Medical Center in Homburg/Saar, Germany. DESIGN Retrospective study. METHODS The topographical and tomographical results of the NPE were assessed using the Pentacam HR and the biomechanical corneal properties using the Ocular Response Analyzer (keratoconus match index [KMI], corneal hysteresis [CH], and corneal resistance factor [CRF]) and the Corvis ST (topographic biomechanical index [TBI] and Corvis biomechanical index) and compared those results with a normal control group (CG). RESULTS The clinical records of 26 patients recruited from the Homburg Keratoconus Center diagnosed with a very asymmetrical corneal ectasia were reviewed. The NPE (8.5 ± 1.5 mm Hg) showed a significantly more pathological CH (P < .001) compared with the CG. The CRF was also significantly more pathological (P = .04) for the NPE (8.3 ± 1.5 mm Hg) compared with the CG. The NPE (0.62 ± 0.32) showed a nonsignificant (P = .08) more pathological KMI compared with the CG. Nineteen (73.1%) of 26 NPE had a KMI less than 0.72 and were considered pathological. Compared with the CG, the TBI of the NPE (0.19 ± 0.25) did not differ significantly overall (P = .57). However, 5 (19.2%) of 26 eyes had a TBI more than 0.29 and were considered pathological. CONCLUSIONS Topographically and tomographically NPEs in very asymmetrical corneal ectasia frequently showed biomechanical changes. This should be considered before planning any type of refractive corneal surgery in such patients.
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- 2021
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42. Descemet Membrane Endothelial Keratoplasty (DMEK) for Severe Verrucous Posterior Polymorphous Corneal Dystrophy with Uncommon Clinical and Ultrastructural Findings
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Tim Berger, Berthold Seitz, Ursula Löw, Fidelis Flockerzi, Ursula Schlötzer-Schrehardt, and Loay Daas
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Ophthalmology - Abstract
To report a case of severe verrucous posterior polymorphous corneal dystrophy (PPCD) and cataract, which was treated with Descemet membrane endothelial keratoplasty (DMEK) and simultaneous cataract surgery as a triple procedure (Triple-DMEK).A 62-year-old female patient presented to our department for co-evaluation of advanced PPCD with cataract and progressive light sensitivity in both eyes. The clinical examination demonstrated unusual clinical findings with prominent verrucous lesions on the posterior surface of the cornea without corneal decompensation. We performed a Triple-DMEK in case of simultaneous cataract. The corneal tissue was examined by light and transmission electron microscopy.Intraoperatively, it was difficult to remove the verrucous structures completely after classical descemetorhexis. Light microscopic examination demonstrated epithelium-like transformation of the corneal endothelium by immunostaining (cytokeratin AE1/3 staining). Transmission electron microscopy revealed thickening of Descemet's membrane (18.5 to 30.0 µm). The anterior banded layer had a normal structure and was slightly thickened (3.5 to 5.5 µm). A normal posterior non-banded layer (PNBL) was observed but thinned (2.5 to 4.0 µm) or missing. It was followed by an altered PNBL with abnormal fibrillary inclusions, which was strongly and variably thickened (11.0 to 24.5 µm). The corneal endothelium was degenerated, partially absent, and epithelial-like altered. The nodular lesions were found to consist of a few degenerated cells that were embedded in an amorphous extracellular matrix interspersed with collagen fibers, which were not arranged in regular lamellae, forming the corneal stroma. The occurrence of pigment granules among the cellular debris suggested that the cells were endothelial cells. The corrected distance visual acuity improved from 20/50 to 20/30 in the right eye (+ 0.00/- 1.75/157°) and from 20/60 to 20/30 in the left eye (+ 0.00/- 1.75/33°), with significant improvement in light sensitivity.The clinical and ultrastructural findings seem to be an unusual variant of the typical characteristic appearance of a PPCD. This case demonstrates that Triple-DMEK is feasible even in very advanced dystrophic changes of the posterior corneal surface, with good morphological and functional results.Wir berichten von einer schweren verrukösen hinteren polymorphen Hornhautdystrophie (PPCD) und Katarakt, die mit Descemet Membrane Endothelial Keratoplasty (DMEK) als Triple-Prozedur (Triple-DMEK) behandelt wurde.Eine 62-jährige Patientin stellte sich in unserer Klinik zur Mitbeurteilung einer fortgeschrittenen PPCD mit Katarakt und ausgeprägter Lichtempfindlichkeit in beiden Augen vor. Die klinische Untersuchung ergab einen fortgeschritten klinischen Befund mit auffälligen verrukösen Läsionen auf der Hornhautrückfläche ohne endotheliale Dekompensation. Wir führten eine Triple-DMEK bei gleichzeitiger Katarakt durch. Das Hornhautgewebe wurde mittels Licht- und Transmissionselektronenmikroskopie untersucht.Intraoperativ war es schwierig, die verrukösen Strukturen nach klassischer Descemetorhexis vollständig zu entfernen. In der lichtmikroskopischen Untersuchung konnte eine epithelartige Veränderung des Hornhautendothels mittels einer Immunfärbung (Cytokeratin AE1/3) festgestellt werden. Die Transmissionselektronenmikroskopie zeigte eine Verdickung der Descemet-Membran (18,5 – 30,0 µm). Die vordere gebänderte Schicht hatte eine normale Struktur und war leicht verdickt (3,5 – 5,5 µm). Eine normale hintere, nicht gebänderte Schicht (PNBL) konnte dargestellt werden, war jedoch verdünnt (2,5 – 4,0 µm) oder fehlte. Darauf folgte eine veränderte PNBL mit abnormen fibrillären Einschlüssen, die stark und variabel verdickt war (11,0 – 24,5 µm). Das Hornhautendothel war degeneriert, teilweise fehlend und epithelartig verändert. Die warzenartigen Läsionen bestanden aus wenigen degenerierten Zellen, die in eine amorphe, mit Kollagenfasern durchsetzte extrazelluläre Matrix eingebettet waren, die nicht in regelmäßigen Lamellen angeordnet waren (kein korneales Stroma). Das Vorkommen von Pigmentgranula im Zelldebris ließ darauf schließen, dass es sich hierbei um Zellen endothelialer Herkunft handelte. Der korrigierte Fernvisus verbesserte sich von 20/50 auf 20/30 am rechten Auge (+ 0,00/− 1,75/157°) und von 20/60 auf 20/30 am linken Auge (+ 0,00/− 1,75/33°), wobei sich die Lichtempfindlichkeit deutlich verbesserte.Die klinischen und ultrastrukturellen Befunde scheinen eine ungewöhnliche Variante des typischen charakteristischen Erscheinungsbildes einer PPCD darzustellen. Dieser Fall zeigt, dass die Triple-DMEK auch bei sehr fortgeschrittenen dystrophischen Veränderungen der Hornhautrückfläche mit guten morphologischen und funktionellen Ergebnissen durchführbar ist.
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- 2022
43. Approval rates for corneal donation and the origin of donor tissue for transplantation at a university-based tertiary referral center with corneal subspecialization hosting a LIONS Eye Bank
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Agata Anna Wykrota, Isabel Weinstein, Loïc Hamon, Loay Daas, Elias Flockerzi, Shady Suffo, and Berthold Seitz
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Universities ,Research ,Organ donor card ,Correction ,General Medicine ,Eye bank ,RE1-994 ,Eye Banks ,Tissue Donors ,eye diseases ,Organ donation ,Tertiary Care Centers ,Cornea ,Ophthalmology ,Keratoplasty ,Humans ,sense organs ,Retrospective Studies ,Corneal transplantation - Abstract
Background With the increasing demand for corneas, eye banks must optimize the tissue donation, collection, and selection process. This retrospective monocentric study analyzed the approval rates for corneal donation and the origin of and reasons for discarding donor corneas from 2010 to 2019. Methods Data included the number of deceased, approval or rejection by the family for corneal donation and contraindications. Corneal grafts were included from all deceased persons who were full-body and multi-organ donors at the Saarland University Medical Center (UKS) and from external institutions. Additional analyzed parameters included endothelial cell count (ECC), blood sample serology for infections, and conjunctival swab testing . Results A total of 1748 corneoscleral buttons were harvested from 10,265 deceased persons (17% with no contraindication) at the UKS between 2010 and 2019, with a consent rate of 23.3%. The number of explants increased from 136 in 2010 (15% of the deceased, total = 925) to 251 in 2019 (21%, total = 1214). Both the general and department-specific data showed similar percentages for corneal donation over the years, with intensive care and palliative units recently providing the most corneas. The increase in the number of corneas processed by the cornea bank over the years (368 in 2010 compared with 857 in 2019) was linked both to a better internal supply in 2010 (262, 71.2% of the total) compared with 2019 (519, 60.6%) and to an external supply by reinforcement of cooperation with external hospitals, including Luxembourg in 2010 (106, 28.8% of the total) compared with 2019 (338, 39.4%). A total of 195 of 377 corneas (52%) were discarded in 2009 compared with 260 out of 715 (36%) in 2019. The main reasons for discarding were low ECC (36% of discarded corneas in 2009; 11% in 2019), positive conjunctival swab (11% in 2009; 13% in 2019), and blood sample serology (6% in 2009 and in 2019). Conclusion Despite an increasing number of donors, the demand for corneas is still rising. Improved cooperation with internal departments and with external clinics has led to an increasing number of explanted corneas. The main reason for discarding corneas was low ECC, followed by a positive conjunctival swab for fungal or bacterial contamination and serology. Increased donation rates and continued improvements in collection and selection processes are necessary to cover the high demand for corneas.
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- 2022
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44. Excimerlaser-gestützte DALK: Ein Fallbericht aus dem Homburger Keratokonus Center (HKC)
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Loay Daas, Navid Ardjomand, Tarek Safi, Berthold Seitz, and Loïc Hamon
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Gynecology ,Dua’s Layer ,medicine.medical_specialty ,business.industry ,Übersichten ,Keratoconus ,Deep anterior keratoplasty lamellar keratoplasty ,Pre-Descemet’s layer ,Excimerlaser-gestützte Trepanation ,Corneal Transplantation ,Ophthalmology ,Treatment Outcome ,DALK ,Eximer laser-assisted trephination ,Medicine ,Humans ,Lasers, Excimer ,Prädescemetale Schicht ,business ,Tiefe anteriore lamelläre Keratoplastik ,Keratoplasty, Penetrating - Abstract
The aim of excimer laser-assisted deep anterior lamellar keratoplasty (excimer-DALK) is, as in mechanical DALK, the treatment of keratectasia (keratoconus and pellucid marginal degeneration), stromal scars or stromal corneal dystrophy. A prerequisite for surgery is the absence of (pre‑) Descemet's scars and an intact endothelium.After excimer laser-assisted trephination to 80% of the corneal thickness at the trephination site, intrastromal air injection (so-called big bubble) and lamellar corneal preparation, a lamellar anterior transplantation of the endothelium-free donor tissue is performed. The technique combines the advantages of DALK and excimer laser trephination. We describe the steps of an excimer-DALK from the Homburg Keratoconus Center (HKC).Excimer-DALK is a viable treatment option for patients with intact endothelium. In cases of intraoperative perforation, conversion to excimer-perforating keratoplasty (PKP) with all the advantages of excimer laser trephination remains feasible.INDIKATIONEN: Ziel der Excimerlaser-gestützten DALK (Excimer-DALK) ist, wie bei der mechanischen DALK, die Behandlung von Keratektasien (Keratokonus und pellucide marginale Degeneration), stromalen Narben oder stromalen Hornhautdystrophien. Voraussetzung für die Operation ist die Abwesenheit von (prä)descemetalen Narben sowie ein gesundes Endothel.Nach der Excimerlaser-gestützten Trepanation auf 80 % der kornealen Dicke an der Trepanationsstelle, einer intrastromalen Lufteingabe (sog. „Big-Bubble“) sowie einer lamellären Hornhautpräparation erfolgt eine lamelläre anteriore Transplantation des endothelfreien Spendergewebes. Diese Technik kombiniert die Vorteile einer DALK und einer Excimerlaser-Trepanation. Wir beschreiben die Schritte einer Excimer-DALK aus unserem Homburger Keratokonus Center (HKC).Die Excimer-DALK stellt bei Patienten mit gutem Endothel eine gute Behandlungsmöglichkeit dar. Bei einer intraoperativen Perforation bleibt die Möglichkeit einer sog. Konversion zur Excimer-PKP mit allen Vorteilen der Excimerlaser-Trepanation.
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- 2021
45. The Reliability of Successive Scheimpflug Imaging and Anterior Segment Optical Coherence Tomography Measurements Decreases With Increasing Keratoconus Severity
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Elias Flockerzi, Achim Langenbucher, Berit Elzer, Kassandra Xanthopoulou, Berthold Seitz, Timo Eppig, and Loay Daas
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Adult ,Male ,Keratoconus ,Materials science ,Scheimpflug principle ,Optical coherence tomography ,Anterior Eye Segment ,medicine ,Humans ,Pentacam hr ,Dioptre ,Reproducibility ,medicine.diagnostic_test ,business.industry ,Patient Acuity ,Outcome measures ,Corneal Topography ,Reproducibility of Results ,Middle Aged ,medicine.disease ,eye diseases ,Ophthalmology ,Disease Progression ,sense organs ,Tomography ,Nuclear medicine ,business ,Tomography, Optical Coherence - Abstract
PURPOSE This study assesses the reliability of successive measurements of tomographic parameters in different keratoconus (KC) stages with 2 different devices. METHODS A total of 125 eyes (13 controls: 24 eyes, and 73 patients with KC: stages 1|2|3|4, n = 24|24|26|27 according to Topographical KC Classification) were repeatedly examined 5 times with the rotating Scheimpflug tomograph (Pentacam HR, Oculus, Wetzlar, Germany) and an anterior segment optical coherence tomograph (Casia 2, Tomey, Nagoya, Japan). Outcome measures included 1) mean anterior (KA) and 2) mean posterior powers (KP), 3) mean anterior (AC) and 4) posterior cylinders (PC), 5) maximal anterior power (Kmax), and 6) thinnest corneal thickness (TCT). The results were compared using the Wilcoxon matched pairs test considering P values
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- 2021
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46. Descemetolyse nach komplizierter Kataraktoperation – nicht immer ist eine DMEK nötig
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Ibrahim Qozat, Isabel Weinstein, Loay Daas, Kassandra Xanthpoulou, and Berthold Seitz
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Cataract extraction ,Ophthalmology ,medicine.medical_specialty ,business.industry ,Descemet Stripping Endothelial Keratoplasty ,medicine ,business - Published
- 2021
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47. Reproducibility of Non-Invasive Endothelial Cell Loss Assessment of the Pre-Stripped DMEK Roll After Preparation and Storage
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Loay Daas, Kolja Berg, Tarek Safi, Berthold Seitz, Katja Schulz, and Achim Langenbucher
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Male ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,Descemet membrane ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Cell Count ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Prospective Studies ,Descemet Membrane ,030304 developmental biology ,Microscopy ,0303 health sciences ,Reproducibility ,Chemistry ,Endothelium, Corneal ,Non invasive ,Reproducibility of Results ,Corneal Endothelial Cell Loss ,Tissue Donors ,Endothelial stem cell ,Endothelial cell density ,Ophthalmology ,Tissue and Organ Harvesting ,030221 ophthalmology & optometry ,Female ,Tissue Preservation ,Descemet Stripping Endothelial Keratoplasty ,Biomedical engineering - Abstract
Purpose To present a novel, reproducible, and noninvasive method to quantify endothelial cell loss (ECL) of pre-stripped endothelial Descemet membrane lamellae (EDML) caused by its preparation and storage for 5 days. Design Prospective laboratory investigation. Methods Thirty EDML were stripped from corneoscleral discs and placed in a well plate containing organ culture medium 1 without dextran. An additional 5 corneoscleral discs were also placed in the same medium and served as a control group. Endothelial cell density (ECD) was measured without any additional manipulation by using spectral microscopy following an extensive protocol by which 3 clear images from the center and periphery were used for each measurement, and each measurement was repeated 5 times. ECD was measured before and directly after preparation and on days 1, 2, and 5 of storage. Results The average ECD of the 30 corneoscleral discs, which later underwent stripping, was 2,292 ± 308 cells/mm2 vs 2,129 ± 222 cells/mm2 for the 5 corneoscleral discs of the control group. The ECL of the control group was significantly lower than that of the EDML group (P Conclusions A highly reproducible, noninvasive method was presented for measuring the ECD of the EDML. Prestripped EDML lose a significant amount of cells, up to 11%, due to the preparation process and up to 23% after 5 days of storage. Therefore, shipping them after several days of storage to be used in a DMEK surgery cannot be recommended.
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- 2021
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48. The Homburg Cross-Stitch Marker for Double-Running Sutures in Penetrating Keratoplasty
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Shady Suffo, Loay Daas, and Berthold Seitz
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medicine.medical_specialty ,Sutures ,Computer science ,Suture Techniques ,Surgery ,03 medical and health sciences ,Ophthalmology ,0302 clinical medicine ,Cross-stitch ,Suture (anatomy) ,Learning curve ,030221 ophthalmology & optometry ,medicine ,Humans ,Biomarkers ,Keratoplasty, Penetrating ,030217 neurology & neurosurgery - Abstract
Until now, the double-running cross-stitch according to Hoffmann used in penetrating keratoplasty (PKP) has been routinely carried out by simply using a sense of proportion. As a result, the estimation of the precisely defined entry and exit points of the sutures and, by extension, the success of the running cross-stitch suture was completely dependent on the practical experience of the surgeon. Therefore, we introduced the cross-stitch marker as a supporting instrument for PKP surgery.Description of the Homburg cross-stitch marker with an exact step-by-step guide on how the instrument is implemented while performing a PKP to mark entry and exit points for sutures including a video to demonstrate the use of this instrument.The new Homburg cross-stitch marker ensures the precise localisation of the entry and exit points of the suture. This new instrument allows inexperienced surgeons in particular to feel very confident when performing the running sutures.Surgeons with little experience can completely avoid using their still imprecise sense of proportion and significantly shorten the learning curve for this procedure.Bis jetzt wurde die fortlaufende Kreuzstichnaht nach Hoffmann bei der Durchführung der perforierenden Keratoplastik (PKP) mithilfe des bloßen Augenmaßes durchgeführt. Hierdurch war die Einschätzung der genau definierten Einstich- und Ausstichstellen und dadurch der Erfolg der fortlaufenden Kreuzstichnaht komplett von der praktischen Erfahrung des Operateurs abhängig. Aus diesem Grund haben wir den Kreuzstichnaht-Marker als unterstützendes Instrument für die PKP-Chirurgie eingeführt.Beschreibung des Homburger Kreuzstichnaht-Markers mit einer genauen Schritt-für-Schritt-Anleitung, wie das Instrument bei der Durchführung einer PKP zur Markierung von Eintritts- und Austrittspunkten für Nahtmaterial eingesetzt wird, einschließlich eines Videos zur Demonstration der Verwendung dieses Instruments.Der neue Homburger Kreuzstichnaht-Marker gewährleistet die präzise Lokalisierung des Eintritts- und Austrittspunktes der Naht. Mit diesem neuen Instrument können vor allem unerfahrene Chirurgen die fortlaufenden Nähte sehr sicher durchführen.Chirurgen mit wenig Erfahrung können ihr noch ungenaues Augenmaß kompensieren und die Lernkurve für dieses Verfahren deutlich verkürzen.
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- 2020
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49. Histoacryl-Kleber zur Akutversorgung von Hornhautperforationen bei nekrotisierender herpetischer Keratitis
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Loay Daas, Berthold Seitz, Ursula Schlötzer-Schrehardt, Adrien Quintin, Shady Suffo, Fidelis A. Flockerzi, and M. El Halabi
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medicine.medical_specialty ,business.industry ,Kasuistiken ,Enbucrilate ,Antiviral Agents ,Cornea ,Ophthalmology ,Adhesives ,medicine ,Keratitis, Herpetic ,Humans ,business - Published
- 2020
50. Thickness and Curvature Changes of Human Corneal Grafts in Dextran-Containing Organ Culture Medium Before Keratoplasty
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Achim Langenbucher, Loïc Hamon, Berthold Seitz, Katja Schulz, Adrien Quintin, Loay Daas, Isabel Weinstein, and Stephanie Mäurer
- Subjects
Male ,Time Factors ,Materials science ,genetic structures ,Organ Preservation Solutions ,Plasma Substitutes ,Organ culture ,Curvature ,Radius of curvature (optics) ,Cornea ,03 medical and health sciences ,chemistry.chemical_compound ,Organ Culture Techniques ,0302 clinical medicine ,Optical coherence tomography ,medicine ,Humans ,medicine.diagnostic_test ,business.industry ,Corneal Edema ,Dextrans ,Eye bank ,Organ Size ,Tissue Donors ,Culture Media ,Ophthalmology ,Dextran ,chemistry ,030221 ophthalmology & optometry ,Female ,sense organs ,Tomography ,Nuclear medicine ,business ,Keratoplasty, Penetrating ,Tomography, Optical Coherence ,030217 neurology & neurosurgery - Abstract
Purpose To determine the changes of corneal thickness and curvature of human corneal grafts in organ culture medium II, containing dextran T500 6%, before keratoplasty. Methods We examined the tomography of 24 corneas from our eye bank transferred from medium I into medium II. Images were repeated hourly during 24 hours using an anterior segment optical coherence tomography. The central corneal thickness (CCT) was measured with the manual measurement tool of the anterior segment optical coherence tomography. The radii of curvature (anterior flat and steep and posterior flat and steep) were measured with a MATLAB self-programmed software for "sterile donor tomography." Results The mean CCT (±SD) at baseline (T0) was 727 ± 156 μm. It reached 581 ± 103, 506 ± 84, 472 ± 79, and 456±7 μm after 6, 12, 18, and 24 hours, respectively. After 12 hours, 83% of the final deswelling was achieved. The radii of curvature (±SD) at baseline (T0) were (posterior flat, posterior steep, anterior flat, and anterior steep) 6.6 ± 0.5, 6.2 ± 0.5, 7.7 ± 0.4, and 7.4 ± 0.4 mm, respectively. After 24 hours, the radii of curvature reached 6.8 ± 0.1, 6.6 ± 0.3, 7.6 ± 0.1, and 7.4 ± 0.2 mm, respectively. Conclusions The kinetics of the deswelling process in medium II follow a hyperbolic curve. Considering a CCT of 506 μm at T12, we assume that a time interval of 12 hours in medium II might be enough for clinical purposes. This result might help to keep storage in medium II as short as possible to escape potential toxic effects of dextran in medium II. The radius of curvature does not seem to change within 24 hours for all measured surfaces.
- Published
- 2020
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